Standing Committee E

[Mr. Win Griffiths in the Chair]

Health and Social Care(Community Health and Standards) Bill

Win Griffiths: I remind hon. Members that all proceedings relating to part 2 of the Bill other than those relating to Welsh clauses must be concluded by 5 pm. That is just a thought for the Committee to grapple with.Clause 51 Annual reviews

Clause 51 - Annual reviews

Amendment proposed [this day]: No. 31, in 
clause 51, page 18, line 5, leave out 
 'and approved by the Secretary of State'.—[Chris Grayling.]
 Question again proposed, That the amendment be made.

Win Griffiths: I remind the Committee that with this we are discussing the following:
 Amendment No. 360, in 
clause 51, page 18, line 6, leave out 'and approved'.

David Lammy: The Commission for Healthcare Audit and Inspection will develop and propose the criteria for performance ratings. It will use its professional judgment to devise and develop a better performance rating system with constantly improving criteria. The Government accept that we are only two years into an important journey and we want CHAI to continue that development process. My right hon. Friend the Secretary of State's only interest in this area is to be assured that that process reflects priorities that he has rightly set for the health service in the interests of all patient concerns. That must be right.
 I did not think that the settlement was controversial until I heard some of the comments made today. The health service, which was founded by a Labour Government, has been accountable to Parliament through the Secretary of State in this place for more than 50 years. I am surprised, therefore, to hear arguments to take away the Secretary of State's attempt to have some nexus or relationship with those criteria as they are developed.

Chris Grayling: But does not the Under-Secretary realise that it is precisely because so many health care professionals say that they are held back by undue interference from the centre that Opposition Members seek to reduce the influence of the centre?

David Lammy: No. Health care professionals say that they want to see investment going into the NHS and they are worried about proposals to cut that investment. As a result of my responsibility for
 emergency services, for example, I know that they are pleased to see a Government prioritise emergency care and not regard it as the Cinderella service that it was considered before. Health care professionals want innovation and the spread of best practice, and that is being achieved through the Modernisation Agency and other things. They accept the need to drive up performance and to have a tough new inspectorate.
 We are the Government who seek to take that forward, so I do not accept what the hon. Gentleman has to say. Independent inspection equals CHAI using its judgment in assessing NHS performance, but it must be right that the Government, on behalf of patients and the public as a whole, ensure that the criteria reflect priorities that we have rightly set. 
 The hon. Gentleman suggests that we are not concerned with health outcomes. I remind him—he should know this—that last year's performance ratings covered health outcomes. I do not know whether he had a look at those ratings. He will understand that mortality is clearly a health outcome, a very important one. Emergency readmissions are a health outcome, as is returning home from treatment. There are eight indicators in all to measure outcomes of clinical treatments. Again, the hon. Gentleman seems confused about performance indicators and whether they confuse health outcomes. For those reasons, and the reasons that I gave previously, it is right and proper that the elected Government are able to determine NHS priorities. CHAI should provide an independent assessment of how well NHS organisations have met those priorities.

Andrew Murrison: I am grateful for the Under-Secretary's catalogue of health outcomes, and they are laudable, but he should accept that those that he cited concern not only the national health service. Some would argue that the NHS is only part of those health outcomes. In particular, mortality is multi-faceted and emergency re-admission also concerns social services. He must be clear about what he means by health outcomes in relation to the NHS.

David Lammy: I shall not go into semantics and a wider discussion of the clinical aspects of health outcomes. Clearly, mortality is a health outcome. How the hon. Gentleman seeks to determine and define that is a matter for him. The important point is that there is a range of performance indicators and I was seeking to establish—I hope that I did so—that as well as patient-focused outcomes and a capacity focus to some of the indicators, there are also clinical outcomes.

Chris Grayling: The Under-Secretary referred to mortality in relation to health outcomes. Let me tell him a short story about a recent hospital visit, when I was told that an audited activity of general surgeons was the number of amputations they carried out. I should prefer the national health service to achieve a zero figure for the number of amputations carried out, but the saving of a leg, unlike its amputation, would not show up in the figures.
 The Under-Secretary should not be distracted by figures that show activity. What matters, as I keep 
 saying, is whether the NHS makes people better. At the moment, only a small proportion of the measurements have any clinical dimension and that is wrong. We need a system of assessment of our health care system that asks the basic question; is it making people better? We are too tied up with the process and not focused enough on outcomes.

David Lammy: Is the hon. Gentleman really suggesting to the 1.2 million people who work in the NHS every day that they are not making people better?

Chris Grayling: What is most extraordinary and demonstrates the challenge that we face in this country is that in a nation with some of the world's finest and most dedicated health care professionals, our system still fails to deliver the quality of health care that is available in other European countries. We should be ashamed of that.
 I conclude by referring the Under-Secretary to two comments about the Government's approach that justify our amendment. First, Dr. Gill Morgan of the NHS Confederation said last year: 
''The current level of micro-management of the national health service by government is worse than ever before. The Department of Health gets involved in far too much detail, which individual organisations have the capacity to sort out themselves.''
 The BMA said: 
''Artificial targets imposed on an overstretched service cannot be met without resorting to ingenious massaging of the figures. It does not fool, nor does it help, patients.''
 We believe that the time has come for the Secretary of State to take a step back and to trust organisations such as CHAI to do the right job for patients in this country. A clause that includes the phrase 
''approved by the Secretary of State''
 in relation to the way in which we measure the effectiveness of our health care system is unnecessary and should be struck out of the Bill. 
 This is a matter that we have pursued throughout our debates on the Bill and we shall seek to return to it at some stage. However, for the moment, I beg to ask leave to withdrawn the amendment. 
 Amendment, by leave, withdrawn 
 Amendment made: No. 289, in 
clause 51, page 18, line 16, leave out subsection (6).—[Mr. Hutton.]
 Question proposed, That the clause, as amended, stand part of the Bill.

Jon Owen Jones: I am sorry to take up more of the Committee's time, but I did not speak earlier and I want to make some general points about the arguments made against the clause and in support of various amendments.
 The Opposition parties have argued against assessing performance, although they say that they oppose assessment of various aspects of performance. In effect, however, they argued against the accountability that the health service should have to the taxpayers, its paymasters, and the spokespersons on behalf of the paymasters; the Government.

Chris Grayling: I must make it absolutely clear that we did not argue against performance assessment, but against an artificial and flawed rating system that distorts relationships between hospital institutions and is unjust to those that do good clinical work. That should not happen.

Jon Owen Jones: I am aware that the hon. Gentleman has made that point on various occasions. However, he has also argued generally against performance review. Both Opposition parties have in effect argued that prestigious professional organisations should not be accountable to the taxpayer or to the Government on behalf of the taxpayer. They should be allowed to carry on in their own way, trusting that they have the best interests of the taxpayer at heart without any direct accountability to the taxpayer. Producer groups will promote that argument in any circumstance.
 It surprises me that the Conservative party chooses to be the champion of producer interests by saying that the producers are right and should be allowed to get on with the job, given the money; or, under a Conservative Government, given some of the money but with 20 per cent. taken off. In effect, it is saying, ''Let them get on with their work and don't worry your pretty little head about it.'' That system might have some merit if we had another form of accountability. If the health service was in such a good state that it had excess capacity in almost all areas so that its consumers had a great deal of choice about where they went for treatment, accountability could be given directly to them. 
 Unfortunately, that is not the world in which we live. We live in a world in which the health service has suffered decades of under-investment and has insufficient capacity to offer any realistic choice, except to people who can afford it. That sort of accountability does not exist, so we must have another sort of accountability; a set of indicators of performance that the Government of the day sets out on behalf of the taxpayer, to whom they are accountable. It is not a perfect system. I can agree with arguments against individual types of performance indicators on the grounds that they are distorted, but all too often the Conservatives and the Liberal Democrats argued against the principle of subjecting those esteemed professionals to any form of direct accountability to the taxpayer.

Gary Streeter: I am following the hon. Gentleman's argument; it is important to get the balance right. However, he should accept that we in the Opposition recognise the need for some monitoring and supervision of health care in the UK. We all want the same thing; the highest quality outcome. However, does he accept that the current method of assessment can be, and in many cases is, too bureaucratic, intrusive and centralised? The proposals in the Bill would make matters worse. It is that to which we are opposed, because we want the system to be better rather than worse.

Jon Owen Jones: I do not accept that, which is why I am discussing the matter in the clause stand part debate. I am not arguing about any specific performance
 indicator. I accept that perverse incentives can be included in any system and I am sure that this system is not perfect. However, all too often, the argument that has been put forward has been against the principle of assessing professional organisations and making them accountable.
 I am sure that it is not only the medical outcomes of a particular institution that matter to the taxpayer, but the efficiency with which it achieved those outcomes. It matters if a particular hospital is inefficiently run and is wasting vast amounts of money, or is performing particular operations far less efficiently than another institution. It must be made accountable for that. That is why, earlier in the debate, I expressed more sympathy than most of my colleagues for the idea of extending the role of competition. 
 However, if accountability cannot be achieved by increasing competition, it must be achieved by introducing a rigorous form of inspection, and performance targets for which people are accountable. That may not be the best form of accountability but, under the circumstances, it is better than saying that we trust the British Medical Association, the General Medical Council and the Royal College of Nursing to perform, and just give them the money. I do not believe that to be an adequate answer to give to the taxpayer.

Andrew Murrison: I have listened carefully to the hon. Gentleman's remarks, and there is much wisdom in what he says. However, does he not agree that we have moved on? What he says would have been true 20 years ago, but it no longer is, because there is much more openness about the results of our hospitals. We briefly discussed the Dr. Foster software and similar examples. The results are there for everyone to see.

Jon Owen Jones: I could not be so sanguine. I was the Health Minister in Wales when we first saw the results of the Bristol scandal on infant deaths. We are only a couple of years on from that, and I could not say that we were in a position to trust the professional organisations to ensure that they alone should be the arbiters of standards and accountability in their professions. I do not believe that to be adequate; the taxpayer and the patient both need a better form of accountability. My colleagues on the Front Bench have not invented a perfect form of accountability, but I would not want to see it thrown away because of some peculiar new-found Conservative trust in producer interest.

Paul Burstow: I shall make a response in this interesting clause stand part debate initiated by the hon. Member for Cardiff, Central (Mr. Jones). I shall quickly recap on the position that I took on behalf of my colleagues this morning. The point that we argued then, which I am recapping on now because of the hon. Gentleman's remarks, was that our amendment would have removed from the Bill an approval by the Secretary of State for the criteria to be drawn up by CHAI. The hon. Gentleman, from his remarks, still seems to think that the indicators are to be drawn up by the Government but, as I understand it, the criteria envisaged in the new system will be conceived—in the context of the standards and of
 Government policy—by the commission and then approved by the Secretary of State.
 The point that I sought to make to the Committee this morning, which the hon. Gentleman clearly mistook, was to draw a comparison with the Audit Commission and its responsibilities on just the points that he mentioned; the efficiency and effectiveness of the organisations that it audits. The Audit Commission is responsible for making decisions on what performance information it should seek. That is provided for in the Audit Commission Act 1988. In that earlier debate, I expressed my concerns about the way in which performance management in the NHS would be dealt with. That was an indication of why the welcome independence for that commission was not being extended to this commission. I do not think that the hon. Member for Cardiff, Central has done justice to his good points by misrepresenting the points that I put forward this morning.

Chris Grayling: I echo some of what the hon. Member for Sutton and Cheam says. Some mutters have come from the Minister of State about effectively providing a justification for the producer side of the NHS. [Interruption.] He is muttering under his breath at this moment.
 The truth is that we believe in an independent inspectorate. One part of the complex jigsaw puzzle that will provide real improvements to health care in this country is a genuinely independent inspectorate. Some of the things that the Government have done in establishing CHAI are right. They have gone a step in the right direction, but their good work is being let down by the millstones that are still left hanging around the neck of the new inspectorate, including the fact that it cannot ultimately escape the veto, judgment and insistence of the Secretary of State on the criteria that the Secretary of State chooses, and the fact that it is still tied in to a flawed rating structure. 
 I accept many of the points that the hon. Member for Cardiff, Central made. We do not want to see measurement and assessment disappear from the NHS. Everyone in the NHS, as in any walk of life, should be subject to some degree of scrutiny over what they are doing. But we happen to think that the current scrutiny is skewed much too much towards process rather than quality of care and work. We would like to address that. The hon. Gentleman will recall that earlier in the debate I used the example of the eight-minute arrival time for ambulances.

Win Griffiths: Order. I appreciate that I was not here this morning and did not hear the debate, but there is no need to present the same arguments in the clause stand part debate. Perhaps hon. Members could find some different examples so that we do not just have a re-run of the debate on the amendments.

Chris Grayling: That was not actually an example I used this morning, but one to which I referred on a separate occasion. That example makes the point well about the importance of balancing process and clinical. I am much more concerned that the NHS should look at where an ambulance trust succeeds in reaching a patient and reviving them so that they make a recovery, rather than simply at the eight-minute
 target time for getting to an incident when a 999 call comes in. I would expect a truly independent CHAI to seek to include such examples in its criteria.
 I am anxious about the inevitable pressures of politics; the inevitable pressure of a No. 10 policy unit that needs to be seen to deliver on behalf of its master. There is no doubt that there are too many reports coming out of Whitehall of enthusiasm, to put it kindly, from No. 10 to get things done as quickly as possible, which is leading to a drive for targets that is impeding professionals in their work.

David Lammy: The hon. Gentleman said he supports an independent inspectorate. Does he support its forerunner, the CHI?

Chris Grayling: Clearly, CHI has made a valuable contribution but it could be strengthened by having greater independence. None of us would say that the Government did a bad thing in setting up CHI. Governments do good and bad things; the establishment of the commission was a step in the right direction. If CHI were a truly independent body, that would be a step further in the right direction. We are anxious about the retention of ties to Whitehall.

David Lammy: Does the hon. Gentleman agree with the CHI's report, about which a press release was issued yesterday, which described how national standards have led to better and more consistent care, and how investment in new and existing premises have made a difference? The chairman said:
''We do not reach a conclusion that everything is rosy in the NHS, but nor do we conclude that it is generally failing. The bottom line is the NHS as a whole is getting better.''

Chris Grayling: What is going wrong in the NHS is that the Government's huge additional investment is not delivering the quantum leap in health care that the country wants.

Win Griffiths: Order. The debate is running away from the content of clause 51.

Chris Grayling: Thank you, Mr. Griffiths. I was trying to respond to the Under-Secretary, who is hanging on my every word.
 I do not doubt the sincerity of the hon. Member for Cardiff, Central, but in return I ask him to accept the Conservative party's desire for as much independence as possible to be given to the new commission. The freer it is from Whitehall, the freer it will be from the Secretary of State's involvement in its work. Thus it will be a genuinely independent scrutineer and watchdog of the performance of the health service, from the work of individual clinicians in hospital units to the work and strategy of the Secretary of State. It can do that job only if it is independent. Too much of the clause, and the Bill, chip away at that independence, and that is not right. 
 Question put and agreed to. 
 Clause 51, as amended, ordered to stand part of the Bill.

Clause 52 - National reviews

David Lammy: I beg to move amendment No. 436, in
clause 52, page 18, line 19, leave out 'into' and insert 'of'.

Win Griffiths: With this it will be convenient to discuss Government amendments Nos. 437, 438, 440, 442, 447 and 445.

David Lammy: Amendments Nos. 436, 437, 440 and 445 make subtle drafting changes suggested by parliamentary counsel to clauses 52, 53 and 66. The consequence of amendment No. 438 will make it clear that in discharging its functions CHI will be able to carry out an inspection of any NHS body or any other person who provides, or is to provide, health care. For example, that may enable CHI to assess the suitability of premises and/or other commissioning arrangements that are intended to provide health care before they are put into use.
 Amendment No. 442 makes it clear that under its functions of promoting or undertaking comparative or other studies and improving the economy, efficiency and effectiveness of the exercise of any of the functions of a PCT, a strategic health authority or an English NHS trust, CHI may inspect any English NHS body other than a special health authority and/or any person exercising the functions of such a body. Special health authorities are excluded from such inspection as we have decided to avoid overlap with those functions that fall within the remit of the National Audit Office. 
 Amendment No. 447 was tabled to make it clearer that the clause will enable the Commission for Social Care Inspection to carry out an inspection on any local authority in England when carrying out studies on economy and efficiency in the provision of local authority social services. We always intended that the clause would enable CSCI to do that. Although the Bill would have that effect, the amendment would provide an additional subsection, putting the matter beyond doubt and clarifying it.

Chris Grayling: I have two questions for the Under-Secretary. First, will the extension of the inspection powers to individuals permit CHAI to inspect complementary practitioners that are used alongside NHS trusts? The Under-Secretary will be aware that, increasingly, complementary medical practitioners, such as osteopaths and chiropractors, are operating in local medical centres and sometimes in hospitals. I should be grateful if the Under-Secretary made it clear whether they come under the umbrella of inspections set out in the changes that he has just outlined.
 Secondly, I want to inquire about the inspection regime for the laboratories that were part of the Public Health Laboratory Service until the formation of the Health Protection Agency on 1 April. The Under-Secretary will be aware that, until 1 April, a number of laboratories fell within the ambit of the Public Health Laboratory Service. They were sited in hospitals around the country and provided, in particular, microbiology support to the health service. They were also part of the network monitoring diseases, outbreaks and epidemics nationwide. As of 1 April, those laboratories have almost totally moved to 
 national health service trusts. They are now sited in, and owned and managed by, the trusts in whose premises they formally sat. 
 The Under-Secretary has made the point that the special health authorities—the Health Protection Agency is a special health authority—are exempt from inspection by CHAI. Will he explain the inspection regime for the former Public Health Laboratory Service laboratories? Are they simply covered by the process of CHAI inspecting a trust, or will CHAI carry out some form of inspection of the work of laboratories generally? Will the National Audit Office retain any kind of assessment role of the work that laboratories do and the part that they play in the national work of the Health Protection Agency?

George Young: The Under-Secretary began by explaining that some of the amendments are subtle. Can he explain to the Committee the subtlety of deleting ''conduct'' in ''conduct an inspection'' and inserting ''carry out''? What is the difference between those things?
 ''Review'' and ''investigation'', which appear quite often in clauses 52 and 53, seem to be almost alternative words. The same is true of the word ''inspection''. Those three words are used almost interchangeably. Will the Under-Secretary explain the difference between a CHAI review, investigation and inspection?

Andrew Murrison: I seek clarification on the role of others who might inspect or survey health bodies; in particular, the Audit Commission. How will it interact with CHAI to ensure that there is no overlap between what the organisations do? I cannot find anything in the Bill to make me confident that there will not be an overlap. It is in the interests of both organisations to co-operate closely.

David Lammy: If care is provided for an NHS body, complementary practitioners will be within CHAI's scope, to answer the question of the hon. Member for Epsom and Ewell (Chris Grayling). I just want to make it clear that ''persons'' can also mean the legal identity of a person and, therefore, the independent sector.
 Public laboratories within NHS trusts are also covered by CHAI if they are no longer run by the special health authority, but the hon. Gentleman will also know that there is a duty of co-operation between CHAI and other inspectorates. They could liaise and produce a joint piece of work if they so wished. We are not seeking to prescribe that endeavour.

Andrew Murrison: The Under-Secretary will know that the Public Health Laboratory Service will form part of the Health Protection Agency. I wonder whether what he has just said will still apply when the HPA is inaugurated.

David Lammy: I thought that I had said that the inspectorate of special health authorities is the NAO, but there is a duty of co-operation. For public authorities that fall within particular trusts, CHAI has a nexus. That is an arrangement where one would expect the inspectorates to talk to one another and
 formulate protocol on the way that they wish to proceed. I am advised that ''carry out'' rather than ''conduct'' is used for consistency purposes in the Bill. The Bill draws on several pieces of legislation in bringing the inspectorates together.

George Young: If that is the case, why does subsection (6) refer to conducting a review or investigation instead of carrying one out?

David Lammy: We are attempting to tidy up the document to make it clear. If the right hon. Gentleman has found other areas where we may need to make that change, I shall get back to him on that. I am grateful for his contribution. Inspection, review and investigation are part of the same attempt to ensure that it is clear when, for example, CHAI is conducting a review into the performance of diagnostic treatment centres in the NHS and wants to review that service of facility. There may have been an investigation where there was an element of controversy or where CHAI had been requested to carry out that investigation by some party. An inspection as a general term can mean the whole process. The right hon. Gentleman will know that there can be some flexibility within which the terms are used, but the Government are genuinely attempting to tidy up the Bill and bring some clarity to those general points.

Andrew Murrison: I am now more confused than I was on the issue of the Public Health Laboratory Service, which I assume is subject to inspections by the Commission for Health Improvement. I should be grateful if the Under-Secretary clarified that, and confirm that when the PHLS becomes part of the Health Protection Agency it will not be directly subject to CHAI but to the National Audit Office. I think that was the thrust of what he said.

David Lammy: Yes, it was. On the first point, I said that where public laboratories are within trusts, they come under the auspices of CHAI.
 Amendment agreed to. 
 Amendments made: No. 290, in 
clause 52, page 18, line 21, leave out 
 'other than NHS foundation trusts'.
 No. 291, in 
clause 52, page 18, line 23, leave out 
 'other than NHS foundation trusts'.—[Mr. Lammy.]

David Lammy: I beg to move amendment No. 292, in
clause 52, page 18, line 24, at end insert— 
 '(1A) If the Secretary of State so requests, the CHAI must conduct— 
 (a) a review under subsection (1)(a) of the overall provision of a kind of health care specified in the request; or 
 (b) a review under subsection (1)(b) of the provision of health care, or health care of a kind specified in the request, by or for NHS bodies of a description so specified. 
 (1B) The Secretary of State must consult the Assembly before making a request under subsection (1A).'.

Win Griffiths: With this it will be convenient to discuss the following:
 Government amendment No. 315.

David Lammy: Following the removal of the exception of NHS foundation trusts from CHAI's
 national review function, amendments Nos. 292 and 293 insert new subsections to place a duty on CHAI to conduct national reviews of particular types of health care as specified by the Secretary of State. The combined effect of the amendments enable CHAI to conduct national reviews of care provided by and for all NHS bodies and of particular types of health care as it and the Secretary of State may request.
 Amendment No. 292 places the Secretary of State under a duty to consult the National Assembly for Wales before making any such request in undertaking any national review. In conducting such a review, CHAI will be placed under a duty to take into account the appropriate statement of standards as provided by clauses 41 and 42. 
 Amendment No. 315 redrafts clause 76(3) to clarify that the Secretary of State may request the CSCI to conduct both national and local studies of a particular service or user group. As currently drafted, it could be argued that subsection (3) allows the Secretary of State to request reviews only of particular local authorities, which was not our intention. The Secretary of State may want to ask the CSCI to conduct a national review of child protection services, and the amendment makes it explicit that it could be a national review of a particular service or service user group.

Chris Grayling: I have a couple of points for the Minister.
 It makes clear sense to have some ability to take a national view of the provision of health care services. Amendment No. 292 requires the Secretary of State to consult the Welsh Assembly, but what would happen if we were dealing with the provision of a specialist service of which there is only one facility in the country? Great Ormond street hospital is an obvious example, as it is Britain's premier children's hospital. It is the sole provider of a number of services in the United Kingdom, and it brings together for treatment children from all parts of the United Kingdom. 
 Therefore, with the proviso that I recognise the potential difficulties with the structure of devolution legislation, is it not logical for such reviews to be able to cover health care provision and requirements across the UK, including Scotland and Northern Ireland, particularly as Northern Ireland is not currently governed by the Assembly? Even if it were governed by the devolved Assembly, would it not sometimes be necessary to take a UK-wide view? For example, we may need to check whether we have adequate or too much provision in one area or whether we need to refocus resources. We may have to ask whether we need the Department of Health and the three devolved assemblies to work together on a particular issue; perhaps the need to establish a specialist burns or cancer centre for the UK.

Win Griffiths: Order. The Bill is not about the whole of the United Kingdom. This clause deals with England and Wales, so the hon. Gentleman's views on how it should be extended to the whole of the UK are irrelevant to the debate on these amendments.

Chris Grayling: You will correct me if I am wrong to ask this question, Mr. Griffiths, but why would the Bill limit such a review to England and Wales? Does the Under-Secretary believe that a review covering England and Wales would reflect nationwide priorities in specialist aspects of our health service?

Win Griffiths: Order. Whatever feelings the hon. Gentleman has about the United Kingdom, I have heard this debate before. Those views need not and should not be made in the context of the two amendments.

Chris Grayling: I am happy to accept your guidance, Mr. Griffiths.
 When the Secretary of State has secured a joint review for England and Wales with the consent of the Assembly, what powers will he have? I shall give the Under-Secretary the specific example—we have discussed it on a few occasions in Committee—of a cross-border acute trust providing services from one side of the border to the other. Let us suppose that a significant devolution of services to community-based facilities on one side of the border had not been replicated on the other side of the border. An investigation would be carried out under clause 52(1)(b), which provides for an investigation of 
''the provision of health care, or a particular kind of health care, by and for NHS bodies, other than NHS foundation trusts, of a particular description.''
 The example involves a specific investigation at the request of the Secretary of State into the provision of community-based services to support an acute centre in a cross-border area. If the review says, ''The problems we have in this area are being caused by the fact that all the community facilities are on one side of the border and not on the other'', does he have the power to secure a solution or is he solely at the whim of a decision taken at the Assembly? Is his only option returning to the Assembly to ask for its help? I should be grateful if the Under-Secretary clarified what happens after the review. What powers does the Secretary of State have to act after the review?

David Lammy: I have the sense that the hon. Gentleman is trying to rehash last week's argument about the Welsh Assembly. I said to him then that we cannot return in Committee to the discussions that we had in this place about devolution. I was not a Member of Parliament at the time, but I know that the discussion was heated in 1999 and that a settlement was made. A national review—this is why it is called a ''national'' review—examines a particular service, and the Secretary of State shares the information with his colleagues in Wales, in the understanding that there will be a Welsh response to the review's outcome. It is not the case—the hon. Gentleman would like this—that the Secretary of State in England tells his colleagues in Wales how they should or should not behave.
 Following the elections a few weeks ago, Conservative Members will be disappointed to hear some of the hon. Gentleman's arguments in Committee and will be interested to read Hansard tomorrow. The settlement was established in 1999 and, 
 in a sense, the Bill corresponds to it and extends it. Like all the Ministers in the Department of Health, the Secretary of State is engaged in constant dialogue with his colleagues in Wales, who seek to bear down on specifically Welsh issues.

Chris Grayling: Given all that the Under-Secretary says about the Secretary of State's inability to intervene in a devolved matter, I am grappling with the idea of a national review. If a national review of children's services concludes that a new specialist children's hospital is required to meet a particular health care need, will the English NHS build it for the Welsh or will it be a joint venture? I am grappling with the purpose of a national review if there is no ability to follow it through with specific action.

David Lammy: I am rather confused. I believe that I was here this morning and last week, and I believe that the hon. Gentleman was here as well. If I am right, and this is not some ''Dallas''-type Bobby Ewing dream, we discussed the standards that my right hon. Friend the Secretary of State is charged with applying to the NHS and that the National Assembly for Wales is charged with applying to the health services in Wales. Those standards are informed by several considerations, including national reviews. It is patently obvious that action would result from an important review into, for example, child protection services or something of that manner.
 Amendment agreed to.

David Lammy: I beg to move amendment No. 293, in
clause 52, page 18, line 24, at end insert— 
 '(1C) In conducting a review under this section in relation to any health care the CHAI must take into account— 
 (a) the standards set out in statements published under section 41, where the health care is provided by or for an English NHS body or cross-border SHA; 
 (b) the standards set out in statements published under section 42, where the health care is provided by or for a Welsh NHS body.'.
 Amendment No. 293 would ensure that CHAI acted consistently when performing its functions. Clauses 46, 51 and 53 already require CHAI to take the statements of standards into account when performing annual reviews of NHS foundation trusts and other NHS bodies and when performing other reviews and investigations. Indeed, that is what I was just saying. The amendment would insert a new subsection that placed a duty on CHAI to take into account the standards set by my right hon. Friend the Secretary of State and by the National Assembly when undertaking its national reviews.

Chris Grayling: This point may belong to another part of the debate. The amendment refers in subparagraph (a) to
''the standards set out in statements published under section 41, where the health care is provided by or for an English NHS body or cross-border SHA''—
 ''cross-border'' is the word that concerns me—and then in subparagraph (b) to 
''the standards set out in statements published under section 42, where the health care is provided by or for a Welsh NHS body.''
 Will the Under-Secretary clarify whether services that are provided on the Welsh side of the border in a 
 cross-border SHA will be subject to English standards? What will happen in the case of a practitioner who serves patients in the cross-border SHA area and in the adjoining Welsh SHA area? I should be grateful if he clarified those points.

David Lammy: My hon. Friend the Member for Cardiff, Central effectively raised the point about the relationship and proximity that CHAI would have to English patients receiving care on the Welsh side of the border. When that came up last time, I said that CHAI has a nexus to deal with services in such areas. Clearly, in looking at those standards, CHAI will be minded to be aware of the Welsh standards.
 I said that we would not tie CHAI, or HIUW, the health inspection unit for Wales, in the National Assembly. We would expect them to work together, draw up protocols and do joint reviews, or to come to determinations about the way in which they wished to take those cross-border issues forward. But, yes, a cross-border special health authority is subject to English standards, whether it is operating in England or in Wales. However, the only cross-border special health authority that I can think of is the UK transplant service.

Chris Grayling: I am grateful to the Under-Secretary for that point of clarification, but I want to press him on one point. In relation to a cross-border SHA—which, therefore, would be subject to English standards—would CHAI have to measure a clinical practitioner, or whoever it may be, against two different sets of standards in the same place doing the same job, in Wales? There is a risk that even greater confusion will arise than our discussions have revealed, because a clinic established on the Welsh side of the border that is providing a specific service within a cross-border SHA is subject to CHAI investigations. However, because it operates in Wales, it is also subject to Welsh standards. Therefore, on the English side of the border, not only do we risk having two sets of standards working at the same time, but CHAI might make a rare foray into Wales, armed with two sets of standards to carry out the inspection. Is that right?

David Lammy: I do not know about the hon. Gentleman, but many people on the English side of the border make forays into Wales on a regular basis; I know that I do. In a sense he confuses the special health authority, because in his earlier example he referred to an individual receiving particular care on the Welsh side.
 The Bill refers to a special health authority, and I can think of no special health authorities that provide services to individuals. However, if there are any, or if some should come about, we would expect CHAI to talk to the National Assembly for Wales and establish appropriate protocols. 
 Amendment agreed to. 
 Amendments made: No. 437, in 
clause 52, page 18, line 25, leave out 
 'subject to this Part, conduct' 
 and insert 'carry out'.
 No. 294, in 
clause 52, page 18, line 28, leave out 
 'other than an NHS foundation trust'.
 No. 438, in 
clause 52, page 18, line 29, at end insert 'or is to be'.—[Mr. Lammy.]

Paul Burstow: I beg to move amendment No. 364, in
clause 52, page 18, line 32, at end insert 
 'and shall send a copy of any such report to the Comptroller and Auditor General.'.

Win Griffiths: With this it will be convenient to discuss the following:
 Government amendment No. 439 
 Amendment No. 365, in 
clause 53, page 19, line 16, at end insert 
 'and shall send a copy of any such report to the Comptroller and Auditor General.'.
 Government amendment No. 441 
 Amendment No. 403, in 
clause 53, page 19, line 23, at end add— 
 '(10) The Comptroller and Auditor General shall from time to time lay before the House of Commons a report of any matter which, in his opinion, arises out of report or studies of the CHAI under this Part and ought to be drawn to the attention of that House.'.
 Amendment No. 366, in 
clause 56, page 20, line 35, at end insert 
 'and shall send a copy of any such summary to the Comptroller and Auditor General.'.
 Amendment No. 34, in 
clause 56, page 20, line 36, leave out subsections (4) to (6).
 Government amendment No. 443 
 Amendment No. 373, in 
clause 117, page 51, line 7, at end insert— 
 '(5A) Where a review or study is conducted under this section the CSCI and CHAI shall send a copy of any such joint report to the Comptroller and Auditor General. 
 (5B) The CSCI and CHAI must, on request, provide the Comptroller and Auditor General with all material relevant to a review or investigation under this section.'.
 Government new clause 5—Provision of material.

Paul Burstow: This group of amendments is one of two that address the reporting relationship between the Commission for Healthcare Audit and Inspection and the National Audit Office, or the Comptroller and Auditor General. The amendments would insert into the Bill the provisions of the Audit Commission Act 1998. Although we are glad that many parts of the Bill stipulate that the Comptroller and Auditor General can seek from the commission relevant and background material arising out of inquiries and studies that it has conducted, it does not stipulate that the commission should send a copy of the report to the National Audit Office in the first place.
 That may seem blindingly obvious, but it would be better to state it in the Bill, as parliamentary counsel seemed to think was appropriate when they drafted what became the Audit Commission Act 1998. I want to know what changed in administrative practice in 
 law that led parliamentary counsel to come to a different conclusion in this case. 
 Why does the Bill not require the commission to send a copy of its report to the NAO and the Auditor General? That is why the amendments were tabled. I hope that they will be regarded merely as tidying-up amendments to ensure that we have a law that is consistent with past law and that the NAO has the benefit of the reports—and the ability to know that those reports exist—and can, as a consequence, seek detailed information from the commission if it sees fit to do so to facilitate any reports that it might choose to produce.

Chris Grayling: Amendment No. 34 is a probing amendment, designed purely to extract from the Under-Secretary an explanation of the provision. In fact, the amendment jumps ahead to clause 56. How does he envisage the relationship between CHAI and the Audit Commission? Clearly, an important relationship is established under the Bill. The Government envisage the Audit Commission carrying out a number of functions on behalf of CHAI. The amendment is designed to secure information as to what sort of work the Under-Secretary expects that to be, and on what occasions he expects CHAI to subcontract its work to the Audit Commission.
 Most particularly, we seek assurances that the Government are not creating a multiple inspection structure. The Under-Secretary will be aware that any participation by the NHS in a review—whether it is a review of a particular area of the NHS or a comparative study as referred to in clause 56(1)—involves a huge investment of time by NHS professionals and management teams, which takes them away from their core function of running the service for which they are responsible. 
 Given that a second body is being put into the equation, we want to understand how the relationship will work between the bodies and how the Government will ensure that there is no unnecessary duplication of effort, that we do not expose NHS management teams to endless periods of inspection unnecessarily and that we do not write into the Bill an extension of the inspection bureaucracy in an undesirable way. I should be grateful if the Under-Secretary explained the three subsections to which the amendment refers, and set out precisely how he sees the role of the Audit Commission in its work alongside CHAI.

David Lammy: This group of amendments deals with the relationship between CHAI and the Comptroller and Auditor General. On the face of it, many of the amendments are moving in opposite directions, but in fact that is not the case. Both Government and Opposition are moving down the same road. The question may be about how far down that road we choose to go.
 Opposition amendments Nos. 364 to 366 would require CHAI to send to the CAG a copy of any report that it made when it carried out a national review under clause 52, other reviews and investigations 
 under clause 53 or value-for-money studies under clause 56. The hon. Member for Sutton and Cheam (Mr. Burstow) raised that point. I sympathise with the aim of the amendment, but it would mean that CHAI was not required to send a copy of its published reports on these functions to one group. 
 I have no doubt that the Comptroller and Auditor General will receive the reports in the natural course of CHAI's business. It is also more important for the Comptroller and Auditor General to have the relevant material behind the reports than to have the reports themselves. The proposal would restrict that to the reports themselves, and Government new clause 5 deals with that. 
 The hon. Member for Sutton and Cheam talked about consistency. The amendments are consistent with section 33(5) of the 1998 Act, which states: 
''The Commission shall . . . on request, provide the Comptroller and Auditor General with all material relevant to the studies.''
 In answer to a question from the hon. Member for Epsom and Ewell, Audit Commission expertise can assist CHAI in early-years building. We would expect that, which is why there is the duty to work together. We expect CHAI to rely on Audit Commission expertise in financial matters if that is important for a study. As an inspectorate, however, CHAI is more concerned with outcomes such as cost-effectiveness and efficiency than with the inputs and the expertise that we would usually expect from the Audit Commission and the local auditors, although they may be used in a particular instance.

Chris Grayling: The Under-Secretary talks about CHAI's focus on cost-effectiveness. Surely the point of the comparative studies mentioned in clause 56 is to judge whether there is cost-effectiveness and whether we are receiving value for money for a particular service? Is there a dividing line between CHAI's involvement in financial assessment and the Audit Commission's involvement in it?

David Lammy: There is a dividing line to the extent that CHAI's focus will be on the outcome; namely, on the result of the care or of a particular exercise. Therefore, its concentration is on the cost-effectiveness of care and the value-for-money exercise at the end of the process. The input—financial management, fiscal responsibility and other requirements—are naturally in the ambit of the Audit Commission. In the early days, we expect the Audit Commission and CHAI to work closely together. However, Audit Commission staff are on secondment with the new CHAI and so they are working together in that sense. The relationship that I mentioned exists in staffing arrangements.

Chris Grayling: The Under-Secretary refers to Audit Commission staff being on secondment with the new CHAI. Interestingly, however, I have just had from the old CHI a request for information for a major research exercise that it is carrying out. Will he clarify the status of the old CHI and the new CHAI?

David Lammy: Forgive me. I am not sure if I understood the hon. Gentleman's question.

Chris Grayling: The Under-Secretary has just said that Audit Commission staff are seconded to the new CHAI, by which I understand that the new CHAI is already up and running, at least in developmental form, yet the old CHI is carrying out detailed research work with patients and opinion formers. I just want to understand the status of the old CHI and the new CHAI.

David Lammy: I thought that this issue had already been raised and clarified. The hon. Gentleman will know that Ian Kennedy is on the shadow board. The aim of an amendment tabled to an earlier clause was to ensure a smooth transition, which the hon. Member for West Chelmsford (Mr. Burns) had mentioned. I explained the shadow arrangements and that the bodies are working together. Until the Bill completes its passage through Parliament, there is no new CHAI, as the hon. Gentleman will know. Under the auspices of the old CHAI and the new shadow board in development, we are working towards the establishment of the new CHAI some time next year, subject to Royal Assent. We will then move into the new arrangements.

Paul Burstow: The Under-Secretary's comments about the relationship between the Comptroller and Auditor General and the commission are useful, but the concern I still have is that when the Under-Secretary referred to section 33(5) of the Audit Commission Act 1998, he did not go on to refer to the fact that subsection (6) of that section specifically stipulates that the Audit Commission, in undertaking studies as to the economy, efficiency and effectiveness of health bodies has to consult with the Comptroller and Auditor General. In other words, it has prior knowledge of the fact that such studies are being undertaken.
 The way in which the Bill is framed does not provide for similar consultation. The Comptroller does not have prior knowledge that a study is taking place. It is perfectly reasonable for the Under-Secretary to advance the idea that in a reasonable world reports will go to the Auditor General as a matter of course, so we do not need to specify that in the Bill. However, the question he did not answer was why parliamentary counsel, in conceiving the 1998 Act, thought it necessary to stipulate that such reports should go to the Auditor General. That seems to be an important clarification; I hope that the Under-Secretary will discuss that with his officials so we can be clear about what has changed between the passing of the 1998 Act and now. 
 Although I think that the amendments are important, I shall give the Under-Secretary the opportunity to consult on them further so that we may return to them at a later stage. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendment made: No. 439, in 
clause 52, page 18, line 33, leave out subsection (4).—[Mr. Lammy.]
 Clause 52, as amended, ordered to stand part of the Bill.

Clause 53 - Other reviews and investigations

Amendments made: No. 295, in 
clause 53, page 18, line 38, leave out 
 'other than an NHS foundation trust'.
 No. 296, in 
clause 53, page 18, line 42, leave out 
 'other than an NHS foundation trust'.—[Mr. Lammy.]

Patsy Calton: I beg to move amendment No. 401, in
clause 53, page 19, line 2, leave out from 'If' to 'conduct' and insert 'requested, the CHAI may'.

Win Griffiths: With this it will be convenient to discuss the following:
 Amendment No. 528, in 
clause 53, page 19, line 17, leave out 'if regulations so provide'.

Patsy Calton: The amendment is quite simple. It is intended to probe whether only the Secretary of State may request an investigation by CHAI. We would be happy to hear from the Under-Secretary whether the only circumstances in which another review or investigation could take place is if the Secretary of State so requested. I shall leave the hon. Member for West Chelmsford to speak to amendment No. 528, which we support.

Simon Burns: Amendment No. 528 is a probing amendment. As hon. Members will be aware from studying the Bill, the clause deals with the reviews and investigations that CHAI can carry out. If my understanding of subsection (7) is correct, once an investigation or review has been carried out and CHAI has made the decision and given its view:
''An NHS body must, if regulations so provide, publish a statement as to the action it proposes to take as a result of any review or investigation conducted''.
 That seems eminently reasonable and a sensible way forward, but I should like to know what is meant by ''if regulations so provide''. Can the Under-Secretary share more of his thinking on how he expects subsection (7) to work? As, presumably, the opposite could be the case in certain circumstances, can he also explain in what circumstances regulations would not ''so provide''? 
 While we are on the subject of regulations, I make a plea to Ministers yet again—I think that it is for the third time. We will be finishing our Committee a week on Thursday and we will come next week to sections of the Bill that include a lot of regulatory powers. Although Ministers could not, for perfectly valid reasons, provide us with draft regulations, I understand that they gave a commitment on the first day—and again when I raised the matter last time—to seek to provide briefings to give us a greater understanding of what the regulations may seek to do. That would help us to conduct our proceedings in a more transparent way. We have, as of now, received nothing. I hope that we will receive what Ministers 
 promised, or, if not, that they will have the courtesy to tell us that we are not going to receive that information, and do so early enough for us to make preparations for that eventuality.

David Lammy: The intention behind amendment No. 401 is rather unclear, although it has been clarified a little today. In practice, I am sure that CHAI will welcome information from patients, health care staff, the public generally or other public bodies if it considers that a review or investigation should take place in a particular area or of a particular NHS body. However, statutory provision is not needed for that.
 It is important that the Secretary of State, in his responsibilities for the NHS, should be able to require CHAI to carry out a particular review or investigation if necessary. The conception of CHAI lay in the Government's considerations of the recommendations in Sir Ian Kennedy's Bristol inquiry report. Should similar events occur in the NHS—the Government are always taking action in a range of ways to try to avoid such an eventuality—it must be right for the Secretary of State to be able to require CHAI to investigate. After all, he has clear statutory duties in relation to the NHS, as I have said today. In meeting those duties, it may be necessary to undertake a review or investigation. It would be inefficient to duplicate resources when CHAI is the inspectorate set up to do that job. For that very important reason, it is right that the Secretary of State can request such a review. 
 It is equally clear that any request for CHAI to undertake specific reviews or investigations would be made by my right hon. Friend not just for its own sake, but only so that issues of vital interest to the public and Parliament receive appropriate consideration by CHAI if they are being neglected. 
 Amendment No. 401 would remove the Secretary of State's ability to require CHAI to undertake a review and consequently might be unable to carry out a major investigation in the public interest. Cases such as Shipman, Beverley Allitt and Climbié illustrate why that would not be satisfactory. 
 Amendment No. 528 would remove the regulation-making power to require NHS bodies to publish a statement of the action they propose to take in response to CHAI reviews or investigations. Our intention is that the requirement will be made. The regulation-making power already allows some flexibility in setting out details of what might be published and when, and allows some differentiation between the expectation of different types of NHS body. To that extent the amendment is unnecessary. Regulations enable flexibility to provide more detail of how and when a statement of action to be taken will be published and, to that extent, the regulations follow in the normal way.

Patsy Calton: The Under-Secretary will understand that we are trying to establish how independent CHAI is. I understood that, in certain circumstances, it should be possible to put a requirement on CHAI, but I should be surprised if it refused to investigate in circumstances such as the Shipman case and so on.
 I am pleased that the Under-Secretary made it clear that patients and others can request an investigation 
 and that seems sound. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendments made: 
 No. 440, in 
clause 53, page 19, line 9, leave out 
 'subject to this Part, conduct' 
 and insert 'carry out'.
 No. 297, in 
clause 53, page 19, line 12, leave out 
 'other than an NHS foundation trust'.
 No. 441, in 
clause 53, page 19, line 20, leave out subsection (8).
 No. 30, in 
clause 53, page 19, line 22, leave out subsection (9).—[Mr. Lammy.]
 Clause 53, as amended, ordered to stand part of the Bill.

Clause 54 - Failings

Patsy Calton: I beg to move amendment No. 404, in
clause 54, page 19, line 33, leave out 
 'running of any person, or'.

Win Griffiths: With this it will be convenient to discuss the following:
 Amendment No. 405, in 
clause 54, page 20, line 2, leave out 
 'the running of any other person, or'.

Patsy Calton: Amendment No. 404 probes the language used in the clause. Subsection (2)(c) refers to:
''significant failings in the running of any person, or the practice of any individual''
 I do not understand the meaning of 
''the running of any person''
 The phrase 
''there are significant failings in the running of any person . . . providing health care for an English NHS body or cross-border SHA''
 does not sit well. I understand the meaning of 
''the running of an English NHS body''
 but not 
''the running of any person''.
 Sitting suspended for a Division in the House. 
 On resuming—

Patsy Calton: I had just about made my point but, for those who were not here before, these probing amendments are trying to determine whether the expression ''running of any person'' makes any sense at all in English. In addition, I ask the Under-Secretary to consider whether the ''running of any person'' refers to the receiver of the running or the person who is doing the running. It could be either, and it would be useful to know which is meant.
 Amendment No. 405 is similar to amendment No. 404 but applies to health care for a Welsh NHS body. I should be grateful for the Under-Secretary's clarification of the meaning of those words.

David Lammy: The practical effect of the amendments would be to remove CHAI's ability to report to my right hon. Friend the Secretary of State or to the National Assembly for Wales if it were of the view that there were significant failings in the running of any person providing health care for an English or Welsh NHS body. In that regard, a person is a legal entity, and the independent sector should be borne in mind.
 It is true that CHAI will also be under a general duty to inform my right hon. Friend the Secretary of State about the provision of independent health care, and to inform my right hon. Friend and the National Assembly about the provision of health care provided by and for NHS bodies more generally. However, removing CHAI's ability to inform the appropriate authority on a case-by-case basis of significant failings in the running of a non-NHS body that provides health care to NHS patients could also have potentially serious consequences and could mean that appropriate measures to rectify the problems were not taken. Clearly, the measures would not encompass intervention by the Secretary of State in the internal running of an independent health care provider, but it might be necessary for commissioners of NHS care to be informed generally of such failings. 
 The amendments would hamper CHAI's ability to operate effectively and to provide the public and Parliament with assurances that appropriate standards of care were being provided by non-NHS service providers. Therefore, I invite their withdrawal.

Stephen Pound: I apologise for interrupting my hon. Friend the Under-Secretary, but I do not believe that he has addressed the point that was raised by the hon. Member for Cheadle (Mrs. Calton). I seldom have any scintilla of agreement with the Liberal Democrats, but she raises an interesting point. While other members of the Committee took advantage of the division to have a cigarette and a cup of coffee, I popped into the Library to do a brief etymological analysis of the expression, ''running a person.'' The only provenance that could be found for the expression is from the world of spy fiction; a 1969 reference from John le Carré to ''running an agent''. The expression appears in that context.
 I would never criticise my hon. Friend the Under-Secretary—it would be foolish to do so—but unless we are descending into the world of the security services, ''running of any person'' is a clumsy expression that should be replaced by ''operational activities'' or something along that line. I hope that my hon. Friend will accept that by raising those doubts I am not in any way supporting the Liberal Democrats, but that I am asking for clarity and transparency in all things.

David Lammy: I am always grateful for the clarity and transparency that my hon. Friend provides. Reference to running a person is already in the Health Act 1999 in the context of the Commission for Health
 Improvement. I might also say, rather more anecdotally, that in terms of a person and the legal identity of an independent organisation, anyone who has pursued the study of law would understand it as a description of a corporate entity. A famous case dealt with that; Salamon v. Salamon.

Patsy Calton: I am grateful to the hon. Member for Ealing, North (Mr. Pound) for clarifying the point I was trying to make. ''Running a person'' does not have a sensible meaning. We who are not lawyers tend to assume that the English language has the meaning that we always thought it had. If there were a special legal meaning of ''running of any person'', it would be helpful if it were stated in the Bill, which is not clear as drafted. In the awful circumstances in which members of the medical profession or others looked at the Bill, they might take offence at the idea that they were merely objects or bodies to be run.
 I will go along with the Under-Secretary's request to withdraw the amendments in the hope that he will table a proposal in plainer English, and in the expectation that we will return to the issue at a later stage if he fails to do so. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

Patsy Calton: I beg to move amendment No. 116, in
clause 54, page 19, line 35, at end insert— 
 '(d) there are significant failings in relation to the provision of guidance to NHS bodies by the Secretary of State.'.
 The amendment is self-explanatory. We are looking for circumstances in which there are significant failings in relation to the provision of guidance to NHS bodies by the Secretary of State. The Under-Secretary will say that there could be no circumstances in which CHAI looked into failings on the part of the Secretary of State, but I should be happy to provide him with one or two examples should he wish me to do so. In the interests of establishing whether CHAI is simply a creature of the Secretary of State or has any independence, it would be useful to discover whether the Under-Secretary accepted that sometimes CHAI might need to investigate provisions made by the Secretary of State.

David Lammy: The amendment would extend CHAI's powers to comment on the suitability of guidance issued by the Secretary of State to the NHS. ''Delivering the NHS Plan'' stated our intention that CHAI should have the key role in providing an independent commentary for patients and the public on how NHS resources have been deployed, and their impact on improving services, raising standards and improving the nation's health.
 CHAI's role in inspecting service delivery will enable it to judge not only whether standards are being met but, importantly, what direct impact they have on patient care. The Bill as drafted recognises that privileged position and the need to ensure that CHAI can provide the Secretary of State with the benefit of its findings. 
 Clause 43(2) as drafted allows CHAI—when it is considered timely or appropriate—to give advice to the Secretary of State on any changes that it thinks should be made to secure improvements in the quality of NHS health care or in relation to the statement of standards provided for in clause 41. While remaining free to provide their own advice on matters of their choosing, the Secretary of State and the National Assembly may ask CHAI to provide additional advice or information on such matters as they may determine. 
 There is no doubt about the guidance that CHAI will be able to give the Secretary of State, including evidence relevant to current or future guidance that he issues. However, as I said earlier, it would be wrong to force CHAI to act as judge of Government policy, in this case to set out guidance to the NHS. We have debated the matter at length, but that important duty must stay with the Secretary of State, and I outlined earlier the purposes and circumstances in which CHAI might choose to give advice. I invite the hon. Lady to withdraw the amendment.

Patsy Calton: I am little disappointed with the Under-Secretary's response. Almost everyone else can be investigated and have their failings checked and published, subject to the Secretary of State's approval, and this is further indication that the Secretary of State will not be subject to the same investigations.
 Any failings might be apparently minor ones, but they could form a pattern, and I offered the Minister the opportunity of hearing one or two examples. One is the provision of guidance to NHS bodies by the Secretary of State; for example, on the announcement in 2001 about the golden hello scheme. A shortage of GPs was anticipated in various areas of the country, and twice in March 2001 the Secretary of State referred to the scheme, in which GPs would be paid £5,000 initially and £10,000 later. 
 The scheme was announced twice and on the second occasion in March, it was announced in the present tense, as if it were already happening. At least one GP was taken on on that basis, but the Government guidelines were issued only in November 2001, several months after the start date, which was not released until November, of April 2001. 
 Sitting suspended for a Division in the House. 
 On resuming—

Patsy Calton: I was in the middle of making the point that it would be a good thing if the Department of Health could be investigated, given that there was an eight-month waiting period after the initial two announcements about golden hellos, and a seven-month delay to the start date, which was not announced until after the guidelines were issued. Anyone who was taken on three or four days before the start date did not get the £10,000.
 I made the point that the reason for the golden hello scheme was that the Government anticipated a shortage of general practitioners. According to a parliamentary answer, the shortage got worse during that period. There is, therefore, a case for CHAI or 
 another organisation to investigate the workings of the Department of Health and perhaps, through that investigation, to encourage it to reach the high standards to which it should aspire. However, I accept the point that the Under-Secretary made, and I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendment made: No. 298, in 
clause 54, page 20, line 12, at end insert— 
 '(5A) The CHAI must also make a report to the regulator where it is of the view that— 
 (a) there are significant failings in relation to the provision of health care by or for an NHS foundation trust; 
 (b) there are significant failings in the running of an NHS foundation trust; or 
 (c) there are significant failings in the running of any person, or the practice of any individual, providing health care for an NHS foundation trust. 
 (5B) A report made to the regulator under subsection (5A) may include a recommendation that, with a view to remedying the failings in question, the regulator take special measures in relation to the NHS foundation trust in question.'.—[Mr. Lammy.]
 Clause 54, as amended, ordered to stand part of the Bill.

Clause 55 - Co-ordination of reviews

Question proposed, That the clause stand part of the Bill.

Chris Grayling: Will the Under-Secretary explain what he envisages the co-ordination of reviews involving? One of the concerns that I have raised is that NHS bodies should not be subject to multiple inspections by different agencies. I therefore welcome what I believe to be the objective of the clause.
 However, I should also like to know whether the co-ordination of reviews means that a single body will carry out the review, and whether that provides for CHAI to take on responsibility from other public bodies for the inspection of a particular service or organisation; or whether the aim of co-ordinating the reviews is to ensure that the inspections do not all happen at the same time. That is particularly relevant in the case of the powers that the Bill gives to the Welsh Assembly to inspect an English trust when it chooses to do so. It would be possible for the Welsh Assembly to set up an inspection of an NHS trust in England that provides services to patients in Wales, without any reference to what was happening in England. 
 Theoretically, the CHAI inspectors and the National Assembly for Wales inspectors could turn up on the doorstep in the same week. I hope that the co-ordination of reviews is designed to ensure that that cannot happen, but I also hope that the Bill goes one step further than that and that the Government do not envisage the National Assembly for Wales sending its inspectors into England to investigate an English trust; rather that CHAI will carry out the review on behalf of another body. Therefore, CHAI, as the organisation with responsibility for carrying out inspections in England, would—whether following a request from an organisation such as the Audit Commission or the 
 National Audit Office or from the National Assembly—carry out the review itself and simply reflect in its work the questions that the other bodies wanted to ask. 
 As I am sure the Under-Secretary will agree, it would be insanity for different bodies to make multiple inspections through a year for different purposes, imposing on management time and distracting management from its job. I hope that the Government's intention in the clause is to ensure that that co-ordination takes place and that CHAI is responsible for doing the fieldwork on behalf of any other body, with a right to inspect an NHS hospital.

Stephen McCabe: I do not have any problem with what the hon. Gentleman is saying, but why does he seek further clarity beyond what is in the Bill? Surely it does not make sense to say that in all circumstances CHAI must carry out the assessment or the investigation. What matters is that there are not multiple investigations. If CHAI is prepared to promote co-ordination using whatever public body is best placed to do that work, is that not sufficient?

Chris Grayling: Absolutely. I totally agree with the hon. Gentleman. However, two different situations could arise. CHAI could simply timetable multiple inspections to ensure that they did not happen at the same time in the same week, or it could bring different bodies together and say, ''We want to ask you questions. Let us give those guys the job of asking the questions, doing the fieldwork and coming back to us with the information, which we can then analyse to meet our specific, different purposes.'' The local management would then have to deal with only one set of inspectors banging on the door.
 My question to the Under-Secretary is whether co-ordination allows that to take place or whether it would simply ensure that the same thing does not happen in the same week as a result of the activities of different organisations.

George Young: My point is a related one. The Under-Secretary will know that the trusts are concerned that they will be exposed to a wide range of different reviews. I want to ask him a question and I quite understand that he may not have the answer now, but I should welcome it at a later date. Could he give the Committee a list of all the public bodies or other persons referred to in the clause that are entitled to carry out reviews or assessments of English NHS bodies or cross-border SHAs? It would be helpful to have a list of those with the competence, so that we have a clearer view of CHAI's role in co-ordinating the work of all those bodies.

David Lammy: On that last point, I can of course provide a full list of those who conduct inspections. It is quite a long list, because of the history of the NHS, the relationship of the royal colleges and so on. This is an attempt to make CHAI primus inter pares, along the lines of the Kennedy report and the Bristol Royal inquiry. In a sense the duty is that of co-ordination. It would be wrong for me to say what form that co-ordination should take, but this is an attempt to reduce bureaucracy and burdens on the front line, as
 Kennedy recommended, and to avoid multiple inspections. However, CHAI's functions are set out in the Bill; it will need to work with others, including the royal colleges, CSCI and other inspectorates to carry them out in the manner that it determines.
 Question put and agreed to. 
 Clause 55 ordered to stand part of the Bill.

Clause 56 - Studies as to economy, efficiency etc

David Lammy: I beg to move amendment No. 299, in
clause 56, page 20, line 21, leave out 'general'.

Win Griffiths: With this it will be convenient to discuss the following:
 Government amendment No. 301. 
 Amendment No. 380, in 
clause 56, page 20, line 31, at end insert— 
 '(1A) The CHAI shall undertake studies designed to enable it to prepare reports as to the impact— 
 (a) of the operation of any particular statutory provision or provisions, or 
 (b) of any directions or guidance given by a Minister of the Crown (whether pursuant to any such provision or otherwise) 
 on economy, efficiency and effectiveness in the exercise of any functions of the bodies listed in subsection (1)(a).'.
 Government amendment No. 343.

David Lammy: Amendment No. 380 would enable CHAI to undertake studies in relation to particular statutory provisions, or any directions or guidance, in an attempt, I presume, to hold the Government to account for their health policies. The amendment is clearly not necessary because clause 43 already provides for CHAI to give advice to or at the request of the appropriate authority, on any matter connected with the provision of health care. Clause 119 also empowers CHAI to make arrangements with Ministers of the Crown in relation to relevant health schemes.
 Government amendments Nos. 299, 301 and 343 are drafting amendments proposed by parliamentary counsel. Amendment No. 299 makes clear CHAI's role of promoting or undertaking comparative studies to improve the economy, efficiency and effectiveness of health care provision, and is a key matter in relation to that general function. Amendment No. 300 makes it clear that CHAI's function of improving the three Es—economy, efficiency and effectiveness—extends to all English NHS bodies, other than special health authorities. We have talked about that.

Paul Burstow: My point may have been covered earlier, but will the Under-Secretary just quickly rehearse which other body will ensure the economy, efficiency and effectiveness of special health authorities? Is it the National Audit Office, or is it some other body?

David Lammy: It is the National Audit Office.
 Reference to the improvement of financial or other management studies is removed by amendment No. 301. CHAI's primary purpose is to improve the quality of health care and it is not appropriate for it to oversee the technical, financial and other management of the NHS, other than where those things have a clear, demonstrable impact on health care provision. The amendment is intended to clarify that. Should the appropriate authority require information on management aspects in relation to quality or the economy, efficiency and effectiveness of a NHS trust, it is at liberty to request CHAI to provide that information under clause 43(3). 
 Amendment No. 343 amends paragraph 10(6) of schedule 8, which deals with the consequential amendments relating to the Audit Commission Act 1998. The effect is to remove from the Audit Commission a wide-ranging power to undertake or promote powers in relation to the provision of services by a range of NHS bodies. The amendment is proposed for consistency. The intention is that CHAI will undertake such things, rather than the Audit Commission.

Paul Burstow: Amendment No. 380 is intended to insert after clause 56(1) the same provisions that apply in respect of the Commission for Social Care Inspection under clause 78(2), on page 31. Clause 78(2) allows for CSCI to
''promote or undertake studies designed to enable it to prepare reports as to the impact of—
(a) the operation of any particular statutory provisions, or
(b) any directions or guidance given by a Minister of the Crown''.
 In his rebuttal of the amendment, the Under-Secretary cited other general provisions rather than a specific power. The danger is that general provisions do not always allow one to undertake a specific purpose. There are Government amendments—we will not debate them but they will be made—that address defects in previous legislation in terms of relying on a general power to exercise a specific purpose. 
 Amendment No. 380 would simply put the Commission for Healthcare Audit and Inspection on the same footing as the Commission for Social Care Inspection. I suspect that one argument is that one deals with an independent provider sector and local authorities while the other deals with the national health service. However, given that the rhetoric and some of the substance of Government policy in ''Shifting the Balance of Power'' is to have a more devolved structure for the delivery and commissioning of health care, that argument is becoming increasingly weak. To deny CHAI the ability to undertake studies on the impact of Government directions is a gap that, if not closed now, will have to be closed later in the Bill's passage. I hope that the Under-Secretary will at least take on board some of those points in his response.

Chris Grayling: I commend the hon. Member for Sutton and Cheam for his amendment, which is a useful contribution. Has the Department examined the impact of statutory provision and regulations on the operation of the health service? Is there an internal
 regulatory impact assessment process for health care issues?

David Lammy: On amendment No. 380, the Government have often said that we are on a journey to an ever-closer relationship between the health care and social care inspectorates. We have included the duty for them to work together in the Bill, but we hope to see the possibility of the two organisations coming together.
 Before that happens, we must understand the different historical contexts of both inspectorates. As the hon. Member for Sutton and Cheam noted, there is a close relationship between the Audit Commission and local authorities, and he will understand how the Audit Commission does not examine social services just in our local authorities but across the board, giving it proximity to the social service inspectorate. We have tried to replicate and continue that under the CSCI. 
 That relationship is slightly different for the purposes of CHAI and, in forming the new body, we wanted to ensure that it took on some of the roles of the Audit Commission. We concentrated on the output, which we felt was important at a time when money is going into the NHS, rather than the input, which can be covered by local audit and the Audit Commission. There are two different historical bodies and relationships, but I assure the hon. Member for Sutton and Cheam that the Government are committed in the long term to the direction of travel that I described.

Paul Burstow: The problem is that even if the Government intend the direction of travel that the Under-Secretary described, we are dealing with primary legislation. The House is unlikely to return to the issue of regulation for some time, as any Government who have made three or four legislative attempts to deal with it in the space of four years are likely to be loth to revisit it in the next two or three years. It will be difficult to include this provision, either in this legislation or through amendments to other legislation, in the future. I am concerned that the provision is not included now. I understand the history, but we are looking to the future.
 It is now five minutes to five, and in looking to the future, I note that there are 50 Government amendments that we will not have the opportunity to scrutinise; unless, by some miracle, the procedures of this place are altered to allow for the time taken by votes in the House to be added on to Standing Committee deliberations. I understand that that will not happen, so, much to the joy of some hon. Members, we will not be able to hear the Under-Secretary explain a range of important amendments to the Bill. That is a cause for concern, and I am sure that many outside this place will find it a cause for regret. It is useful to hear the Under-Secretary explain his amendments and to cross-question him so that we can ensure that they can be clearly understood in the future. 
 Amendment agreed to. 
 Amendments made: No. 300, in 
clause 56, page 20, line 24, leave out from second 'of' to end of line 29 and insert 
 'an English NHS body, other than a Special Health Authority (whether the functions are exercised by the English NHS body or by another person).'.
 No. 301, in 
clause 56, page 20, line 30, leave out paragraph (b).
 No. 442, in 
clause 56, page 20, line 33, at end insert— 
 '( ) For the purposes of this section the CHAI may carry out an inspection of— 
 (a) any English NHS body other than a Special Health Authority; 
 (b) any person exercising the functions of such a body.'.—[Mr. Lammy.]

David Lammy: I beg to move amendment No. 302, in
clause 56, page 20, line 34, leave out 'or otherwise make available'.

Win Griffiths: With this it will be convenient to discuss Government amendment No. 318.

David Lammy: Amendment No. 318 is a minor technical amendment that removes the reference to CHAI and CSCI otherwise making available any recommendations, reports or studies carried out under clauses 56 and 78. There are no circumstances in which we want either of the new inspectorates to make the documents available by publishing them on paper or on the internet. We therefore believe that it will be better to remove ''otherwise make available'' to clarify that the intention is always for CHAI and CSCI to publish such documents as they see fit.
 Amendment agreed to. 
 Amendment made: No. 443, in 
clause 56, page 20, line 36, leave out subsection (4).—[Mr. Lammy.]
 Clause 56, as amended, ordered to stand part of the Bill.

Clause 57 - Additional functions

Paul Burstow: I beg to move amendment No. 419, in
clause 57, page 21, line 6, after 'efficiency', insert ', equity'.

Win Griffiths: With this it will be convenient to discuss amendment No. 420, in
clause 57, page 21, line 7, after 'bodies', insert— 
 '( ) ethical practice in the exercise of functions of English NHS bodies;'.

Paul Burstow: In the remaining three minutes, I want to talk about two points that the amendments raise. Amendment No. 419 would insert ''equity'' after ''economy, efficiency and effectiveness''. The intention is to make it a requirement for CHAI to have regard for equity as well as economy, efficiency and effectiveness in the delivery of health care services by English NHS bodies. That is relevant to how we attempt to close the health inequality gap in this country. It may enable us to start to use the commission as a way of ensuring that issues of equity are also dealt with.
 Amendment No. 420 takes us back to an earlier debate on ethics and ethical practice. If my hon. Friend the Member for Oxford, West and Abingdon 
 (Dr. Harris) were here, I am sure that he would regale the Committee with his expertise on this issue. I shall not do that.

Simon Burns: I do not think that he would, either.

Paul Burstow: The hon. Gentleman makes a comment from a sedentary position that I shall note but not repeat.
 The amendments are intended to elucidate the Government's thinking and to clarify whether the commission can examine this issue in discharging its responsibilities. I look forward to the Under-Secretary's reply in the remaining one minute.

David Lammy: The amendments would add areas to those already listed in which the Secretary of State may advance new functions for CHAI. I sympathise with the amendments but, as I indicated last week, we intend to clarify how the issues of quality and other matters listed in clause 49 apply to CHAI's general functions.
 It being Five o'clock, The Chairman put the Question necessary under the terms of the programme resolution to complete the business. 
 Amendment negatived. 
 Amendment made: No. 303, in 
clause 57, page 21, line 10, leave out 'obtain the consent of' and insert 'consult'.—[Mr. Lammy.]
 Clause 57, as amended, ordered to stand part of the Bill. 
 Question, That clauses 58 and 59 stand part of the Bill, put and negatived.

Claude 60 - Fees

Amendments made: No. 495, in 
clause 60, page 22, line 3, leave out from 'provision' to end of line 12 and insert— 
 '(a) requiring an English NHS body or crossborder SHA to pay a fee in respect the exercise by the CHAI, in relation to that body, of such of its functions under this Chapter as may be prescribed; 
 (b) requiring a person of a prescribed description who provides health care for an English NHS body or crossborder SHA to pay a fee in respect of the exercise by the CHAI, in relation to the health care so provided by that person, of such of its functions under this Chapter as may be prescribed. 
 (1A) The CHAI may not under subsection (1)(b) require a Welsh NHS body to pay a fee.'.
 No. 496, in 
clause 60, page 22, line 19, at end insert— 
 '( ) for the time by which a fee must be paid.'.
 No. 497, in 
clause 60, page 22, line 31, leave out subsection (8).
 No. 498, in 
clause 60, page 22, line 35, at end add— 
 '( ) A fee payable by virtue of this section may, without prejudice to any other method of recovery, be recovered summarily as a civil debt.'.—[Mr. Lammy.]
 Clause 60, as amended, ordered to stand part of the Bill. 
 Clauses 61 and 62 ordered to stand part of the Bill.

Clause 63 - Right of entry: supplementary

Amendments made: No. 304, in 
clause 63, page 23, line 16, leave out 'and take copies of' and insert 
 ', take copies of and remove from the premises'.
 No. 444, in 
clause 63, page 23, line 22, at end insert 
 'and 
 (d) make any other examination into the state and management of the premises and treatment of persons receiving health care there.'.
 No. 305, in 
clause 63, page 23, line 33, after 'enter', insert 'and inspect'.—[Mr. Lammy.]
 Clause 63, as amended, ordered to stand part of the Bill. 
 Clauses 64 and 65 ordered to stand part of the Bill.

Clause 72 - Introductory

Amendment made: No. 310, in 
clause 72, page 28, line 7, after 'under', insert 'subsection (1) and'.—[Mr. Lammy.]
 Clause 72, as amended, ordered to stand part of the Bill. 
 Clauses 73 and 74 ordered to stand part of the Bill.

Clause 75 - Annual reviews and investigations

Amendments made: No. 311, in 
clause 75, page 29, line 9, leave out 'function' and insert 'functions'.
 No. 312, in 
clause 75, page 29, line 12, at end insert— 
 '(4A) The CSCI is to exercise its function under this section in any financial year in accordance with any timetable specified in relation to that year by the Secretary of State.'.
 No. 313, in clause 75, page 29, line 13, leave out 'function' and insert 'functions'. 
 No. 314, in 
clause 75, page 29, line 16, leave out 'function' and insert 'functions'.—[Mr. Lammy.]
 Clause 75, as amended, ordered to stand part of the Bill.

Clause 76 - Other reviews and investigations

Amendments made: No. 315, in 
clause 76, page 29, line 34, leave out from 'conduct' to end of line 39 and insert— 
 '(a) a review under subsection (2)(a); 
 (b) a review under subsection (2)(b) of an English local authority social service of such description as may be specified in the request; or 
 (c) a review or investigation under subsection (2)(c) in relation to the provision of such services as may be specified in the request by such person, or persons of such description, as may be so specified.'.
 No. 316, in 
clause 76, page 29, line 40, leave out 'functions' and insert 'function'.—[Mr. Lammy.]
 Clause 76, as amended, ordered to stand part of the Bill.

Clause 77 - Failings

Amendment made: No. 317, in 
clause 77, page 30, line 34, leave out 'such action must' and insert 
 'the CSCI considers the action should'.—[Mr. Lammy.]
 Clause 77, as amended, ordered to stand part of the Bill.

Clause 78 - Studies as to economy, efficiency etc

Amendments made: No. 447, in 
clause 78, page 31, line 15, at end insert— 
 '( ) For the purposes of this section the CSCI may carry out an inspection of any local authority in England.'
 No. 318, in 
clause 78, page 31, line 16, leave out 'or otherwise make available'.
 No. 499, in 
clause 78, page 31, line 18, at end add— 
 '( ) The CSCI must, on request, provide the Comptroller and Auditor General with any material relevant to a study under this section.'.—[Mr. Lammy.]
 Clause 78, as amended, ordered to stand part of the Bill.

Clause 79 - Joint working with audit commission

Amendment made: No. 448, in 
clause 79, page 31, line 26, leave out subsection (3) and insert— 
 '( ) The Secretary of State may give guidance to the CSCI and the Audit Commission as to which of them should promote or undertake studies which could be promoted or undertaken by either of them. 
 ( ) The CSCI and the Audit Commission must take any such guidance into account in the exercise of their functions.—[Mr. Lammy.]
 Clause 79, as amended, ordered to stand part of the Bill. 
 Clause 80 ordered to stand part of the Bill.

Clause 81 - General considerations

Amendment made: No. 319, in 
clause 81, page 31, line 36, leave out subsection (1).—[Mr. Lammy.]
 Clause 81, as amended, ordered to stand part of the Bill.

Clause 82 - Failure in discharge of functions

Amendment made: No. 320, in 
clause 82, page 32, line 7, leave out 'Chapter' and insert 
 'Act or the Children Act 1989 (c.41)'.—[Mr. Lammy.]
 Clause 82, as amended, ordered to stand part of the Bill. 
 Question, That clause 82 be transferred to the end of line 6 on page 53, put and agreed to.

Clause 83 - Fees

Amendments made: No. 500, in 
clause 83, page 32, line 26, at end insert— 
 '( ) for the time by which a fee must be paid.'.
 No. 322, in 
clause 83, page 32, line 40, at end add— 
 '(8) A fee payable by virtue of this section may, without prejudice to any other method of recovery, be recovered summarily as a civil debt.'—[Mr. Lammy.]
 Clause 83, as amended, ordered to stand part of the Bill. 
 Clauses 84 and 85 ordered to stand part of the Bill.

Clause 86 - Right of entry: supplementary

Amendment made: No. 323, in 
clause 86, page 33, line 27, leave out 'and take copies of' and insert 
 ', take copies of and remove from the premises'.—[Mr. Lammy.]
 Clause 86, as amended, ordered to stand part of the Bill. 
 Clauses 87 and 88 ordered to stand part of the Bill.

Clause 99 - Transfer of functions to CHAI and CSCI

Amendments made: No. 325, in 
clause 99, page 39, line 7, leave out 'this section' and insert 'subsections (2) and (3)'.
 No. 326, in 
clause 99, page 39, line 22, at end add— 
 '(4) In relation to any period after the coming into force of this subsection but before the coming into force of sections 76 and 77, the functions of the National Care Standards Commission under Part 3 of that Act are transferred to the CSCI.'.—[Mr. Lammy.]
 Clause 99, as amended, ordered to stand part of the Bill. 
 Clauses 100 to 102 ordered to stand part of the Bill.

Clause 103 - Meaning of ''independent medical agency''

Amendment made: No. 327, in 
clause 103, page 42, line 14, leave out '2(4)' and insert '2(5)'.—[Mr. Lammy.]
 Clause 103, as amended, ordered to stand part of the Bill. 
 Clause 104 ordered to stand part of the Bill.

Clause 105 - Information and inspection

Amendments made: No. 506, in 
clause 105, page 42, line 34, after 'including' insert 'medical and other'.
 No. 507, in 
clause 105, page 42, line 39, after 'including' insert 'medical and other'.—[Mr. Lammy.]
 Clause 105, as amended, ordered to stand part of the Bill. 
 Clauses 107 to 109 ordered to stand part of the Bill. 
 Clause 111 ordered to stand part of the Bill. 
 Clauses 113 to 115 ordered to stand part of the Bill.

Clause 116 - Co-operation etc between CHAI and CSCI

Amendment made: No. 328, in 
clause 116, page 50, line 22, leave out 'Each of' and insert 'The'.—[Mr. Lammy.]
 Clause 116, as amended, ordered to stand part of the Bill.

Clause 117 - Joint reviews and investigations: CHAI and CSCI

Amendment made: No. 450, in 
clause 117, page 50, line 32, after 
 'body', insert , or to any health care provided by or for an NHS body,'.—[Mr. Lammy.] 
 Clause 117, as amended, ordered to stand part of the Bill. 
 Clauses 118 to 126 ordered to stand part of the Bill.

Clause 127

Information obtained by CHAI: supplementary 
 Amendment made: No. 329, in 
 clause 127, page 55, line 22, after 'documents', insert 'or records'.—[Mr. Lammy.]
 Clause 127, as amended, ordered to stand part of the Bill.

Clause 128 - Information obtained by CSCI: supplementary

Amendment made: No. 330, in 
clause 128, page 55, line 28, after 'documents', insert 'or records'.—[Mr. Lammy.]
 Clause 128, as amended, ordered to stand part of the Bill. 
 Clauses 133 and 134 ordered to stand part of the Bill.

Schedule 8 - Part 2: minor and consequential amendments

Amendments made: No. 343, in 
schedule 8, page 122, line 18, at end insert— 
 '(c) subsection (4).'
 No. 452, in 
schedule 8, page 122, leave out line 22
 No. 344, in 
schedule 8, page 124, line 13, after 'after', insert 'the second'.
 No. 509, in 
schedule 8, page 124, line 36, at end insert— 
 '24A In section 51(1), for the words from ''in relation to'' to ''registration authority'' substitute ''in England in relation to which powers conferred by section 76 of the Health and Social Care (Community Health and Standards) Act 2003 may be exercised to pay to the CSCI''.
 No. 345, in 
schedule 8, page 124, leave out lines 37 to 40 and insert— 
 '25 In section 113, after subsection (1) insert— 
 ''(1A) The powers conferred by this section are exercisable by the Secretary of State if he is satisfied that— 
 (a) the CHAI or the CSCI has without reasonable excuse failed to discharge, or properly to discharge, any of its functions under this Act, or 
 (b) in discharging any of its functions under this Act the CHAI or the CSCI has without reasonable excuse failed to comply with any directions given by him in relation to those functions.''.—[Mr. Lammy.]
 Schedule 8, as amended, agreed to.

Clause 135 - Interpretation of Part 2

Amendments made: No. 508, in 
clause 135, page 58, line 21, at end insert— 
 ' ''personal records'' includes medical records;'
 No. 501, in 
clause 135, page 58, line 24, after 'sections' insert 
 '(CHAI fees: Wales),'.—[Mr. Lammy.]
 Clause 135, as amended, ordered to stand part of the Bill.

Clause 136 - References to the provision of health care

Amendments made: No. 332, in 
clause 136, page 59, line 2, after 'care', insert 'for another person'.
 No. 333, in 
clause 136, page 59, line 4, after 'agreement', insert 'or arrangements'.—[Mr. Lammy.]
 Clause 136, as amended, ordered to stand part of the Bill. 
 Further consideration adjourned.—[Mr. Fitzpatrick.] 
 Adjourned accordingly at twelve minutes past Five o'clock till Thursday 12 June at five minutes to Nine o'clock.